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Baseball Has An Elbow Problem: More Pros Getting Ligament Surgery

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On Friday, Los Angeles Angels pitcher Sean Burnett became the latest player this season to undergo "Tommy John" surgery. In this weekend's MLB draft, at least four players selected had already had the infamous elbow surgery as amateurs.

The operation is named after the first player to undergo the procedure to fix an injured elbow ligament, in 1974. Pitchers are particularly vulnerable to this injury.

The procedure involves taking a tendon from somewhere else in the body — or from a cadaver — and grafting it into place. Pitchers get it most often.

This year, baseball players are on pace to have more Tommy John surgeries than ever, as Fox Sports' Rob Neyer tells NPR's Arun Rath.

"Last year there were ... roughly 50 Tommy John surgeries in all of professional baseball, which was a lot. This year there have already been roughly 45," he says.

This year is outpacing the surgeries in 2012, the year with the current record. There were 67 surgeries total on pro players in 2012, about the same number as all of the surgeries from 1995-2000 combined.

Neyer says that one reason for the uptick is that "pitchers today are bigger and stronger than they've ever been before." Every part of the modern pitcher — shoulder, arm, core — is trained specifically to throw consistently 95 or 100 miles an hour. But the elbow ligament just can't keep up.

"There's a lot of thought now that you can build up the muscles around the elbow ligament, and that might help, but you can't strengthen that ligament itself," Neyer says. "We just can't create an elbow ligament that allows them to do that year in, year out."

On May 28 (the day after Burnett tore the ligament that led to last week's surgery), the American Sports Medicine Institute released a statement on the operation, calling the rash of Tommy Johns an epidemic and laying out recommendations to avoid the injury that necessitates it.

"Do not always pitch with 100% effort," the paper urges. "The professional pitcher's objectives are to prevent baserunners and runs, not to light up the radar gun."

The Sports Medicine Institute — whose chairman is Dr. James Andrews, the orthopedic surgeon best-known for performing the surgery — also recommends avoiding pitching year-round, watching out for and reporting any stiffness or pain in the elbow, reining in effort on drills and practice, and pitching less when fatigued.

But it's tough to implement those recommendations when all the incentives in baseball point the other way, Neyer says — especially because the surgery's success rate hovers around 85 percent.

"The kids want to throw hard. The kids want to get a college scholarship. They want to get a professional contract," he says. "The way you do that is by throwing exceptionally hard, impressing the scouts, impressing college coaches. What is the incentive to not do those things? It's difficult to say."

On the other hand, it was once commonplace for pitchers to throw more than 100 pitches a game, as starting pitchers were often expected to pitch all nine innings. But that culture has changed completely, thanks to an increased awareness of the injury risk posed by pitch counts so high.

You're listening to ALL THINGS CONSIDERED. I'm Arun Rath. So far this baseball season, it seems we've been hearing one name more than any other. Tommy John. What's weird is that Tommy John retired from baseball 25 years ago. But in 1974, he was the first player to undergo a new surgical procedure to fix an injured elbow ligament. The Tommy John surgery, as it's now known, involves taking a tendon from somewhere else in the body, or from a cadaver, and grafting it into place. Pitchers get it most often, but lately the surgery has become so common with amateurs, as well as pros, that some are calling it an epidemic. I spoke with Rob Neyer of Fox Sports, who stopped short of that word. But he says, it's still a huge deal.

ROB NEYER: Last year, there were 50, roughly 50, Tommy John surgeries in all of professional baseball - which was a lot. This year, there have already been roughly 45.

RATH: Lets talk about Sean Burnett, the pitcher for the Angels, who this week, became the latest pitcher to get this kind of surgery. Looking at this picture of him throwing the last pitch before he injured that elbow, it looks sick. I don't know if it's something about the angle, but it doesn't look like an elbow should bend like that. He'd already had the surgery once. Now he's had it a second time. Is that really smart?

NEYER: Well, it's absolutely true that when you watch a picture in super slow motion or you see a still taken that right split-second, it absolutely looks unbelievably unnatural. But they've always basically done this. I just saw a picture of a pitcher in 1910, and he had basically the same pitching motion that pitchers have now. But pitcher today are bigger and stronger than they've ever been before. There's a lot of thought now that you can build up the muscles around the elbow ligament. And that might help. But you can't strengthen that ligament itself. And what we're doing is creating these giant power pitcher, who can throw 95 to 100 miles an hour, routinely, but we just can't create an elbow ligament that allows them to do that year in and year out.

RATH: That speed you're talking about - is that what's causing them to need the surgery? Do we know what the real reasons are for it?

NEYER: No we don't. And that's the real tricky thing. And we have a lot of people, a lot of really smart people who work for baseball teams, all the great doctors who specialize in pitcher. They haven't figured it out. There's some thought that you should sort of limit the number of pitches you throw, and that's been happening for a long time. I think a lot of people now believe teenagers shouldn't be pitching the year round, which many of them do. But, nobody's figured out a magic bullet, to this point. I don't know that anyone is going to for a long time.

RATH: You know, when you're talking about teenagers - and we're hearing about teenagers actually having this surgery. How worried should parents be about the way that their kids are throwing baseballs?

NEYER: They certainly should be very worried. And I think most of them are. When we talk about how do you convince parents not to allow this to happen -it's that - the kids want to throw hard. The kids want to get a college scholarship. They want to get a professional contract. The way you do that is by throwing in exceptionally hard, impressing the scouts, impressing college coaches. You know, what is the incentive to not do those things? It's difficult to say, especially when the success rate of these surgeries is very high. Somewhere between 80 and 85 percent of pitchers come back throwing essentially as well as they did before. So there's not a lot of incentive for teenagers, for college pitchers, young professionals, to stop throwing as hard as they have been, to throw fewer innings than they have been. There's a lot of incentives to keep doing those things.